As many as half of the refugees in Germany were suffering from psychological problems, a study released by Germany’s chamber of psychotherapists found, according to the Guardian. The study, released Wednesday, showed refugees arriving in Germany were suffering from stress, depression and post-traumatic stress disorder. “Forty percent have already had suicidal thoughts or have even attempted to kill themselves,” the study said.

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As schools in Germany prepare for large numbers of children to enter the education system, teachers and counselors will be dealing with a population where 1 in 5 children is suffering from PTSD. That is 15 times higher than any child born in Germany, the study said, attempting to put the problem in perspective for a German audience.

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The German government needed to regulate psychological treatment in refugee centers, Dietrich Munz, the president of Germany’s chamber of psychotherapists, said, adding that only 4 percent of refugees in centers were currently receiving mental health support.

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The study said refugees were victims of rape, violence, torture, displacement and hunger. The war in Syria began in 2011 and has left more than 200,000 people dead and displaced millions. Barrel bombs and chemical weapons have been used in the war. In Iraq, the sexual abuse of Yazidi women who have escaped captivity from the Islamic State has been well documented.

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